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What Doctors Don't Tell You

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October 2020 (Vol. 5 Issue 7)

Glossed over

About the author: 
Cate Montana

Glossed over image

New technology now allows every nail salon to offer gel nails that last an amazing three weeks. Cate Montana gets the lowdown on their safety profile.

Nail polish has a long and colorful history. Originating in China approximately 5,000 years ago, black polish (and red) was reserved for Chinese royalty . . . until Freddie Mercury and David Bowie inspired the Goth look in the early 1970s, making black nails trendy again.

But no matter what the color, right up into the 20th century, nail-polish technology pretty much depended on egg whites, beeswax, vegetable dyes and a lot of buffing. Only with the advent of modern laboratory chemicals and, most recently, the introduction of photoinitiated polymerization, have women had access to the manicure product of their dreams—tough, beautiful, richly colored, long-lasting nail gels—and all at a relatively affordable price.

In 2016, 23 percent of all female consumers went to nail salons to get a gel manicure. Popular across all age groups, the use of gel polish is highest among millennial women aged 25-35 and Hispanic women. Most women have their nail gels redone every two to three weeks, although according to Mintel marketing, in 2013, the average teen girl aged 12-17 changed her gel polish nearly five times a month. (This figure, though, is currently in decline because teens are highly trend-driven and the hot new thing right now is eyebrow makeup.)

As any woman who's had a gel manicure can attest, gels last longer than regular polish—which is made of nitrocellulose resin—by an average of two to three weeks and possibly up to a month, depending on nail growth and care, as opposed to a matter of days—or sometimes, discouragingly, just hours—before the inevitable chipping of regular nail polish happens. And at first glance,
it would seem there are health advantages to gels as well.

Some gel polish manufacturers have ditched the 'toxic trio' of dibutyl phthalate (DBP), toluene and formaldehyde used in most regular polishes. But many have not.

Absorbed through the nail bed and exposed
cuticles, DBP is a known reproductive and developmental toxin, while toluene is a solvent and volatile organic compound used in paints and lacquers, and can cause kidney failure, liver and biliary tract damage, and serious muscle injury (rhabdomyolysis).2 Formaldehyde, of course, is a known systemic neurotoxin.3

In an effort to avoid the use of phthalates, the nail-polish industry turned to alternatives like triphenyl phosphate (TPHP), a chemical used in plastics to increase flexibility. Yet, studies show that TPHP also may be an endocrine disruptor (it interferes with hormones), and may perturb carbohydrate/glucose and lipid metabolism as well as interfere with DNA repair and, at low concentrations, with normal metabolism and cell cycles.4

Another chemical found in many nail gel products is the waxy antioxidant and possible endocrine disruptor butylated hydroxyanisole (BHA). Used in food packaging, pharmaceuticals and cosmetics, BHA is known to induce tumors in rodents and might even trigger tumor development in the human esophagus if used as a food additive.5

Sadly, it's not always possible to tell if any of these toxic materials are in a gel polish (or any other kind of nail product) just by reading the label. In the US, no ingredient approval is required for nail products, and the polishes used in salons are not required to list their ingredients.

And even if products do list ingredients, it's not guaranteed that all of them are actually cited. A joint study by Duke University in North Carolina and the nonprofit Environmental Working Group (EWG) found that two of the eight polishes that tested positive for TPHP had not disclosed its presence on the labels, while the chemical was found in the body of every woman who used the polish for the study.6

Plastic by any other name

Gels fall into the category of acrylics, a special class of monomers (single molecules) and oligomers (a complex of monomers) that readily form bonds with other molecules to create a polymer. Also known as 'synthetic photoinitiators,' these semiliquid monomer and oligomer gels are exposed to ultraviolet A (UVA) radiation during the drying process, at which point the photoinitiators in the gels absorb the UVA light and convert it via a free-radical chain reaction that forces the monomers and/or oligomers to bind together to make an extremely hard polymer.

Gels also contain chemical stabilizers to prevent discoloration, inhibitors to prevent the gel from forming polymers while still on the shelf and pigments to give the gel its color.

A crucial part of the gel process is the use of a nail gel lamp. This little box contains several bulbs that emit the appropriate wavelength of light to activate the photoinitiators in the gel, turning the liquid into a hard polymer finish. But herein lies the major problem with gel polishes: UV light causes skin cancer, melanomas, skin discoloration and bruising, and speeds up skin aging.

Modern gels use long-wave UVA light rather than short-wave UVB, which is even more dangerous. Initially, there were no filters on the UV lamps used to cure nail gels, and high concentrations of both UVA and UVB radiation were emitted. The technology has now advanced, and gel lights now filter out most of the UVB wavelengths, leaving most gel lamps with a UV output that ranges roughly from 320 to 400 nanometers (or billionths of a meter).

Marketed as 'safe' light-emitting diodes (LEDs), many people believe the lamps used in the gel-curing process contain no harmful UV rays. They're wrong. These so-called safe LED lamps emit UVA and a small amount of UVB at high concentrations.

"There's no way around the step of using UVA rays," says Dr Chris Adigun, dermatologist and nail specialist based in Chapel Hill, North Carolina. "They've come up with newer types of lamps. But the lamps that cure the product faster just use a stronger dose of UVA. Nothing's really changed. They're all UVA lamps."

In 2009, researchers at the Wellcome Trust Sanger Institute in Hinxton (near Cambridge) in the UK mapped the genetic material (genome) of malignant melanoma, which allowed them to catalog all the DNA changes that had taken place; the primary mutational signature was DNA damage caused by UV light exposure years before the symptoms actually began.7

What's more, a study comparing UVA and UVB DNA damage found that, while both types of radiation induced DNA-damaging mutations, such changes seemed to be even more mutagenic with UVA than UVB because of "less effective anti-mutagenic cellular responses."8

The International Commission on Non-Ionizing Radiation Protection has set a UV exposure limit of eight hours for outdoor workers. Yet, one study revealed that anyone using a UV nail-curing lamp receives the recommended limit in less than 10 minutes.9 Which doesn't sound so bad—except that UVA exposure adds up.

"Even though people are exposed in very short increments, it's very intense," says Adigun. "It's much more intense than UVA rays emitted by the sun. This kind of light doesn't even exist in the natural state, and the effect
is cumulative."

Dr John Humeniuk, a dermatologist and nail specialist in Greenville, South Carolina, compares nail-curing lights with tanning beds. "The reality is, these light sources run at between 340 to around 380 nanometers, and UVA tanning lights operate between 320 to 400 nanometers. UVA doesn't burn as much as the old-fashioned UVB lights, but it's still a promoter of skin cancers, melanomas and general skin aging."

In July 2009, the World Health Organization placed tanning beds in the highest cancer risk category, designating them 'carcinogenic to humans.'

Humeniuk says he doesn't know how many women actually get their nails done every two to three weeks. But it's clear that doing so for several years running is a bad idea. "You can get more skin cancers and melanomas, skin wrinkling and UV bruising. It all depends on how much you're exposed to it," he says.

It also might depend on your age. There's growing concern that young people are especially susceptible to the damaging effects of UV radiation. As a result, two states in the US, California and Vermont, have banned tanning bed use by those aged under 18. In addition, UV sensitivity may also be increased by genetic factors and the use of certain medications.

The bottom line: if you're going to have gels done every two or three weeks, which is what most women do, Adigun recommends using a physical UV shield (see box, page 59). "Sunscreen is neither effective nor reasonable because most sunscreens require 20 minutes to soak in—and those 20 minutes don't exist in the middle of a manicure.

"They also don't typically block UVA rays as effectively as you need them to—especially when you take into account that these lamps are emitting UVA rays more powerfully than the sun does."

Other issues besides cancer

Studies show that just one application of gel polish can thin the nail plate,10 and there are plenty of horror stories about the damage gels can inflict on nail health. Brittleness, fractures, nail weakness, total nail separation from the
bed and discoloration are just some of the problems that can arise.

And it's not just the gel coating itself that can cause problems. The method of application and removal is also involved. Some salon technicians have the mistaken belief that gels only adhere well to the nail if the nail plate is etched, making the surface more porous and available to the polymer bond. To this end, many technicians sand and scratch the nail, thinning it even further before applying the gel. As the gel coat ages and begins to chip and flake, the temptation to pick at it like a scab is huge. According to Adigun, if a gel coating is chipped and picked off, even more of the nail plate comes off with the gel, thinning and weakening the nail even further.

Aside from penetration through the cuticles, a thin etched nail plate is one of the main pathways for acetone to enter the body. Acetone soaks are used to remove gels, and it's not unheard of for customers to be left soaking their fingers in acetone for up to 15 minutes at a time. Yet, this clear volatile industrial solvent has been linked to inhalation injuries (irritation of mucosal linings),11 as well as Guillain-Barré syndrome, nephrotic syndrome and multiple renal
tubular dysfunction.12

Which brings us to another issue surrounding gel-curing lamps.

Gels are meant to be cured by a lamp emitting a specific wavelength for a specific period of time—with each wavelength matched to a particular product, as every gel product is different.

"The problem," says Adigun, "is nail salons often invest in just one UVA lamp, but they use multiple different products. And so there's a mismatch as to when and how particular products are supposed to be cured under what strength of UVA lamp.

In addition, each product recommends a specific amount of time exposure depending on the strength of the lamp—and the strength of the lamps are all over the map with absolutely no regulation."

According to Adigun, if a gel is properly cured using the correct lamp, when it's time to remove the gels in an acetone soak, the gels simply float off the nail. When product mismatches occur—which is often—the gels end up improperly cured to the nail plate and become very difficult to remove.

"People have to have them sanded off and chipped off," she says. This, of course, causes even more nail damage.

Improper curing also leads to excessive drying of the nail plate, splitting, allergic reactions, tenderness, softening of the nail, and even separation and lifting of the nail plate from the nail bed—a condition called 'onycholysis.'

When this happens, it's not only painful and disfiguring, but it sets the stage for infection. Humeniuk likens this to having a cracked bathroom tile. "When you have a gap between the nail plate and the bed, moisture can get in, and bacteria and yeast can grow."

Some of the most common bacterial infections due to improperly cured gels involves Pseudomonas, notable for the blue-green discoloration that is easily visible under the nail once the polish has been removed. Unfortunately, many women rarely see their own nails because they go from gel application to gel application every few weeks. And if they do glimpse something unusual, or if there's any tenderness, cracking or lifting, the temptation is to quickly cover it all up and ignore it.

This, says Adigun, is pretty much the worst thing you can do. If something's wrong, don't use any sort of polish. An etched nail plate (which can happen with just one gel application) can take up to six months to be repaired. If there's an infection, see a dermatologist.

The best rule of thumb? Be sparing when it comes to nail gels or any other type of polish. "I always tell my patients to allow their nails to rehydrate and repair, and never do back-to-back gels," says Adigun.

Tips for making gel manicures safer

  • Repeatedly putting a load of chemicals on your nails is never a safe thing to do, but there are some precautions you can take to reduce the risk.
  • Use a physical UV shield. Dr Chris Adigun, dermatologist and nail specialist, says to make sure the shield goes up far enough to cover the wrists. She also advises against the use of regular gloves (with the tips cut off)—not even the ones with a UPF (ultraviolet protection factor) rating. "Not all gloves have a true UPF rating," she says. "Many that are made in China do not even have the certificate, even though they say they are UPF-protective." The best product she's found is the YouVeeShield (, which is big enough to fit everyone—plus it folds up, fits into a wallet, and can be used on feet and hands.
  • Don't wear contact lenses when you go to a salon. Soft contact lenses absorb vapors from the air and may even scratch the surface of your eye. After a nail treatment, make sure to wash your hands before touching around your eyes.
  • Don't let your nail aesthetician drill or use a high-speed file to remove previous gels. Drilling, chipping or sanding away old gels damages your nails, making them more porous and brittle.
  • If sanding is unavoidable, cover your mouth and nose as well as you can to avoid inhaling the fine dust produced by the procedure.
  • Check out whether the lamp your salon uses to cure your nails is wavelength-specific to your gel product. Each gel brand specifies the type and wavelength to be used.
  • Choose salons that are well ventilated.
  • Don't take children with you into a nail salon—they are especially susceptible to the toxic effects of the fumes.
  • Never eat or drink in a nail salon. Liquids and foods can absorb toxins directly from the air.
  • Don't smoke. Sparks are never a good thing when you're surrounded by toxic fumes.

A recipe for naturally healthy nails

Want natural-looking, healthy nails? Bone collagen and nail keratin are both structural proteins, and healthy nails are a direct indicator of overall bone health. Like so many things in life, they best way to set the stage for healthy nails (and bones) is a healthy diet with high levels of hydration.


  • Proteins, such as organic lean meats and chicken
  • Foods with high levels of vitamin B12, omega-3 fats and zinc, such as salmon, anchovy, herring, mackerel and oysters
  • Nuts, eggs and beans are high in biotin and vitamin E; eggs are also high in vitamin D, crucial for bone and nail heath
  • Flaxseed has most of the micronutrients needed for healthy nails plus omega-3 fats
  • Oats are a great source of micronutrients such as copper, zinc, manganese, silica and B-complex vitamins—all important for nail health
  • Dark green leafy vegetables like spinach, kale, Swiss chard, dandelion greens, green beans and broccoli are rich in calcium and magnesium, both essential for healthy bones and nails
  • Seeds, bananas, avocados and chocolate are great sources of magnesium
  • Green tea is bursting with antioxidants that help strengthen nails
  • Plenty of spring water, and avoid beverages that dry out your system, like coffee and alcohol.

Nail fixers in your kitchen cupboard

To treat nail infections or dry nails

Tea tree oil and the medium-chain fatty acids in virgin coconut oil are antibacterial/antifungal and help to treat nail infections. Add tea tree oil to any of the oils mentioned below, as they also moisturize and strengthen nails.

Soak fingertips in warm olive, coconut, flaxseed or vitamin E oil and massage nails for about 15 minutes before bed. Instead of rinsing off with warm water, wear cotton gloves to bed and let the oil continue to sink in overnight.

Place raw apple cider vinegar in an equal amount of warm water for a healthy nail soak that contains vital micronutrients; this can also help to treat and prevent fungal infections.

To cleanse or remove polish

Baking soda is a great nail cleaner: using a wet toothbrush, lightly scrub the tops and under the nails.

Lemon juice and white vinegar work together as polish remover. Combine 1 Tbsp of each and soak nails for 5-10 minutes, then dip a cotton ball into the mixture and use it to gently remove polish.

Use natural nontoxic polishes. There are a surprising number of nontoxic polishes on the market today. Our favorites are those with the fewest chemicals: Suncoat, Zoya, RGB and Honeybee Gardens. While they don't last as long as gels, you can go the more natural route for everyday, and leave gel polish for special occasions.

Gels that don't use UV light to cure. There are a few of these gels on the market (but you still need to read the labels for possible toxins), and tests show they last for four or five days. These include OPI, Sally Hansen Miracle Gel, CoverGirl XL Nail Gel and Nails Inc. Gel Effects Polish.

For children, try Piggy Paint. This nontoxic, hypoallergenic polish was developed by a mom horrified by what was in the polishes her little girls were playing with.

Read the labels. Even when they say 'all natural,' that may not mean what you think—after all, cyanide is an 'all-natural' carbon compound too. Look out for ingredients like TPHP, toluene, formaldehyde and dibutyl phthalate (DBP).

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